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Type 1 diabetes Flashcards

1
Q

what is type 1 diabetes?

A

a state of absolute deficiency

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2
Q

how is T1DM diagnosed?

A

fasting glucose >/= 7
random >/= 11.1
symptoms
GAD/IA2 antibodies

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3
Q

which gene is associated to 50% of familial risk of T1DM?

A

HLA

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4
Q

what triggers have been associated with T1DM?

A

viral infections
maternal factors
weight gain

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5
Q

what are the 4 isle auto-antibodies (ICA)?

A

IA-2
IAA
GAD65
ZnT8

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6
Q

what is the antigen for GAD65b?

A

glutamic acid decarboxylase

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7
Q

what is the antigen for IA-2Ab

A

islet antigen 2

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8
Q

what is the antigen for IAA

A

insulin

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9
Q

what is the antigen for ZnT8Ab

A

ZnT8 transporter

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10
Q

what is the function of Glutamic acid decarboxylase?

A

GABA production

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11
Q

does glutamic acid decarboxylase increase or decrease with age?

A

increases with age

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12
Q

which sex is glutamic acid decarboxylase associated with?

A

females less than 10 yrs old

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13
Q

does islet antigen 2 increase or decrease with age?

A

decreases with age

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14
Q

what is the function of insulin?

A

regulates glucose

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15
Q

in which age group does insulin function better?

A

in children

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16
Q

what is the function of ZnT8 transporter?

A

Zn function in beta cells

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17
Q

in which age group is ZnT8 transporter better in?

A

the older

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18
Q

what are the foetal risk factors for T1DM?

A 
Maternal factors:
infection 
age 
ABO mismatch 
birth order 
stress
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19
Q

what are the disease makers that can be found in foetal life?

A

Genetics:
HLA
non-HLA

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20
Q

what are the pre-diabetes risk factors in children?

A 
Auto-immune trigger factors:
viral infecton 
Vit. D deficiency 
Dietary factors
Environmental toxins
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21
Q

what disease markers can be found in pre-diabetic stage in children?

A

auto-immune process:
autoantibodies esp. GAD 65 & IA2
candidate antigens
insulitis

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22
Q

what are the accelerating factors of T1DM?

A 
infection 
insulin resistance 
puberty 
diet/weight 
stress
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23
Q

what are the disease markers/features of clinical T1DM?

A

raised glucose
ketones
decreased insulin
decreased beta cell mass decreased C-peptide

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24
Q

what is the classic triad of presenting symptoms?

A

polyuria (enuresis in children)
polydipsia
weight loss

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25
what presenting symptoms aside from the classic triad are common?
fatigue & somnolence blurred vision candidal infection in established keto-acidosis
26
which 2 candidal infections are commonly presented with T1DM?
pruritis vulvae | balanitis
27
what is the first step of management in T1DM?
``` blood glucose & ketone monitoring insulin carbohydrate estimation regular DSN & dietitian contact medical clinic review regular check of glycemic control annual review assessment ```
28
what type of insulin regimen is initially employed for T1DM?
basal (once daily) bolus with meal
29
what can be used to check prevailing glycemic control?
HbA1c
30
what is assessed in the annual review assessment?
``` weight blood pressure bloods: HbA1c, renal function & lipids retinal screening foot risk assessment ```
31
into which vein is insulin normally secreted?
the portal vein
32
what rate is insulin secreted at in fasted state?
0.25-1.5 units of insulin per hour
33
if a child is diagnosed with diabetes under the age of 6 months, is it likely to be T1DM?
no, more likely to have monogenic diabetes
34
what is LADA?
latent onset diabetes of adulthood
35
how is a diagnosis of LADA established?
by the presence of elevated levels of pancreatic auto-antiboodies in patients with recently diagnosed diabetes who do not initially require insulin
36
what are the other 2 names for LADA?
slowly progressive Type 1 | Type 1.5 diabetes
37
which other genetic disease is common in diabetes?
cystic fibrosis
38
what are the relatively common auto-immune conditions associated with diabetes in general?
``` thyroid disease coeliac disease pernicious anaemia addison's disease IgA deficiency ```
39
what are the rare auto-immune conditions associated with diabetes in general?
auto-immune polyglandular syndromes AIRE mutations IPEX syndrome
40
what are the 4 devices that can be used to administer insulin?
syringe disposable pen reusable cartridge pen continuous subcataneous insulin infusion pump
41
which of the 4 devices cannot be used for self-administration of insulin?
syringe
42
in what pattern is insulin normally secreted?
low basal rate continuously & spikes of post-prandial insulin
43
which insulin regimen aims to mimic normal endogenous insulin production?
basal bolus insulin
44
what is the first line insulin regimen in T1DM?
basal bolus insulin with patients knowing how to calculate insulin dose in relation to food
45
how long does an insulin analogue take to start to work?
10-15 mins
46
when is the peak action of insulin analogues?
60-90 mins
47
how long id the duration of insulin analogues?
4-5hrs
48
how long does it take for soluble insulin to start to work?
30-60 mins
49
when is the peak action of soluble insulin?
2-4hrs
50
how long is the duration of soluble insulin?
5-8 hrs
51
what are the 2 types of basal insulins?
isophane "basal" insulins | analogue basal insulins
52
what are the 2 types of fast acting insulin?
insulin analogues | soluble insulin
53
what is the action length of isophane "basal" insulins like?
intermediate/long acting
54
when is the peak action of isophane "basal" insulins?
4-6 hours after administration
55
whhich of the 2 types of long acting insulin is the longest acting?
analogue basal insulins
56
what are the components of advanced carbohydrate counting?
insulin to carbohydrate ratio (ICR) | insulin sensitivity factor (ISF)
57
what is insulin sensitivity factor also known as?
correction factor (CF)
58
what does an insulin pump administer?
continuous administration of short acting insulin - basal rate
59
what must a patient using an insulin pump do before meals?
deliver manually activated bolus of insulin
60
who is metabolic control evaluated?
home blood glucose monitoring urine testing glycated haemoglobin (Hb1Ac) continuous glucose monitor
61
what is the best way to get a clear picture of metabolic control?
continuous glucose monitor
62
how is glycated haemoglobin formed?
non-enzymatic glycation of haemoglobin on exposure to gluose
63
what are the problems with systems currently used to administer insulin?
``` Insulin injection or pump - into subcutaneous tissue peak too slow to prevent post-meal hyperglycaemic spike - slow clearance ```
64
what are the factors affecting insulin absorption/action?
temperature injection site injection depth exercise
65
when is IV insulin prescribed?
- DKA - role in hyperosmolar hyperglycaemic state - acute illness - fasting patients who are unable to tolerate oral intake
66
what are the indications for a pancreas transplantation?
Imminent or ESRD due to receive or with kidney transplant Severe hypoglycemia/ metabolic complications Incapacitating clinical or emotional problems
67
who is pancreatic islet transplantation usually reserved for?
for those with: episodes of severe hypoglycaemia Severe and progressive long-term complications despite maximal therapy Uncontrolled diabetes despite maximal treatment
68
what are the 4 key steps of islet transplantation?
pancreas donation & retrieval islet isolation islet culture islet transplantation
69
what must be done after an islet transplantation?
close follow up for 4-6 weeks | immunosuppression

Endocrinology (23 decks)

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